When working as a volunteer health care worker, is it possible I contracted the HIV virus?Jan 7, 2009

Two summers ago I volunteered in a developing country. I work mostly in a clinic for men and women living with HIV and AIDS. I often had to change incontinent residents and their soiled bedsheets. I would also have to lift them up while another nurse fully washed their body. While I always wore gloves, my arms were exposed. My last week there I developed a rash on my arm and although I do not remember any blood or fecal matter splshing on to my arm, and the rash, I am concerned about my close contact with these men and the possibility of contracting HIV. Also, some of the men would have dried blood cuts on their faces and I would hug them goodbye as I left each day. What do you think? Am I just being crazy? Or should I be tested asap?

Response from Dr. Frascino

Hi,

What do I think? I think you are a compassionate, generous, warm-hearted, loving individual who deserves our utmost praise and appreciation. I also think you have racked up enormous amounts of excellent cosmic karma that should provide you with a long, healthy, productive and very content existence in this life and the next! BRAVO! As a person living with HIV, please accept my heartfelt thanks for your altruistic and magnanimous volunteer work!

Regarding your HIV-acquisition risk, it's extremely remote at best. For peace of mind, it's fine to get HIV tested; however, I'm quite confident the results will be negative. For our readers' edification I'll repost below some guidelines for caring for folks with HIV/AIDS at home (or elsewhere).

Be well. Stay well.

Dr. Bob

What You Need to Know About HIV and AIDS

If you are going to be caring for someone with HIV infection, you need to understand the basic facts about HIV and AIDS. AIDS (acquired immunodeficiency syndrome) is caused by HIV (human immunodeficiency virus). People who are infected with HIV can look and feel healthy and may not know for years that they are infected. However, they can infect other people no matter how healthy they seem. HIV slowly wipes out parts of the body's immune system; then the HIV-infected person gets sick because the body can't fight off diseases. Some of these diseases can kill them. Signs of HIV infection are like those of many other common illnesses, such as swollen glands, tiring easily, losing weight, fever, or diarrhea. Different people have different symptoms.

HIV is in people's blood, semen, vaginal fluid, and breast milk. The only way to tell if someone is infected with HIV is with a blood test.

There is no vaccine to prevent HIV infection and no cure for AIDS. There are treatments that can keep infected people healthy longer and prevent diseases that people with AIDS often get. Research is ongoing.

HIV slowly makes an infected person sicker and sicker. Diseases and infections will cause serious illness, but people often get better -- until the next illness. Sometimes, HIV can damage the brain and cause changes in feelings and moods, even make it hard to think clearly. Someone with AIDS can feel fine in the morning and be very sick in the afternoon. It can seem like riding a roller coaster, slowly climbing up to feeling good, then plunging down into another illness.

How HIV is Spread

The most common ways HIV is spread are: By having unprotected anal, vaginal, or oral sex with one who is infected with HIV

By sharing needles or syringes ("works") with someone who is infected with HIV

From mothers to their babies before the baby is born, during birth, or through breast-feeding. Taking the drug AZT during pregnancy can reduce the changes of infecting the baby by two-thirds, but will not prevent all babies from becoming infected with HIV.

Earlier in the AIDS epidemic some people became infected through blood transfusions, blood products (such as clotting factors given to people with hemophilia), or organ or tissue transplants. This has been very rare in the United States since 1985, when the test for HIV was licensed. Since then, all donated blood and donors of organs or tissue are tested for HIV. Health care workers, such as nurses, risk getting infected if they are stuck with a needle containing infected blood or splashed with infected blood in the eyes, nose, mouth, or on open cuts or sores. In a few cases, a person sharing a house with a person with HIV infection or taking care of a person with AIDS has become infected themselves. These infections may have been caused by sharing a razor, getting blood from the infected person into open cuts or sores, or some other way of having contact with blood from the infected person. If you are taking care of a person with HIV infection, carefully follow the steps on protecting yourself from infection discussed later.

How HIV is NOT Spread

You don't get HIV from the air, food, water, insects, animals, dishes, knives, forks, spoons, toilet seats, or anything else that doesn't involve blood, semen, vaginal fluids, or breast milk. You don't get HIV from feces, nasal fluid, saliva, sweat, tears, urine, or vomit, unless these have blood mixed in them. You can help people with HIV eat, dress, even bathe, without becoming infected yourself, as long as you follow the steps described later in the section on "Protecting Yourself" later in this brochure. You do get other germs from many of the things listed above, so do use common sense.

Protect Yourself

A person who has AIDS may sometimes have infections that can make you sick. You can protect yourself, however. Talk to the doctor or nurse to find out what germs can infect you and other people in the house. This is very important if you have HIV infection yourself. For example, diarrhea can be caused by several different germs. Wear disposable gloves if you have to clean up after or help a person with diarrhea and wash your hands carefully after you take the gloves off. Do not use disposable gloves more than one time.

Another cause of diarrhea is the cryptosporidiosis parasite. It is spread from the feces of one person or animal to another person or animal, often by contaminated water, raw food, or food that isn't cooked well enough. Again, wash your hands after using the bathroom and before fixing food. You can check with your local health department to see if cryptosporidiosis is in the water. If you hear that the water in your community may have cryptosporidiosis parasites, boil your drinking water for at least 1 minute to kill the parasite, then let the water cool before drinking. You may want to buy bottled (distilled) water for cooking and drinking if the cryptosporidiosis parasite or other organisms that might make a person with HIV infection sick could be in the tap water.

If the person with AIDS has a cough that lasts longer than a week, the doctor should check them for TB. If they do have TB, then you and everybody else living in the house should be checked for TB infection, even if you aren't coughing. If you are infected with TB germs, you can take medicine that will prevent you from developing TB.

If the person with AIDS gets yellow jaundice (a sign of acute hepatitis) or has chronic hepatitis B infection, you and everybody else living in the house and any people the person with AIDS has had sex with should talk to their doctor to see if anyone needs to take medicine to prevent hepatitis. All children should get hepatitis B vaccine whether or not they are around a person with AIDS.

If the person with AIDS has fever blisters or cold sores (herpes simplex) around the mouth or nose, don't kiss or touch the sores. If you have to touch the sores to help the person, wear gloves and wash your hands carefully as soon as you take the gloves off. This is especially important if you have eczema (allergic skin) since the herpes simplex virus can cause severe skin disease in people with eczema. Throw the used gloves away; never use disposable gloves more than once.

Many persons with or without AIDS are infected with a virus called cytomegalovirus (CMV), which can be spread in urine or saliva. Wash your hands after touching urine or saliva from a person with AIDS. This is especially important for someone who may be pregnant because a pregnant woman infected with CMV can also infect her unborn child. CMV causes birth defects such as deafness.

Remember, to protect yourself and the person with AIDS from these diseases and others, be sure to wash your hands with soap and water before and after giving care, when handling food, after taking gloves of, and after going to the bathroom.

Gloves

Because the virus that causes AIDS is in the blood of infected persons, blood or other body fluids (such as bloody feces) that have blood in them could infect you. You can protect yourself by following some some simple steps. Wear gloves if you have to touch semen, vaginal fluid, cuts or sores on the person with AIDS, or blood or body fluids that may have blood in them. Wear gloves to give care to the mouth, rectum, or genitals of the person with AIDS. Wear gloves to change diapers or sanitary pads or to empty bedpans or urinals. If you have any cuts, sores, rashes, or breaks in your skin, cover them with a bandage. If the cuts or sores are on your hands, use bandages and gloves. Wear gloves to clean up urine, feces, or vomit to avoid all the germs, HIV and other kinds, that might be there. There are two types of gloves you can use. Use disposable, hospital-type latex or vinyl gloves to take care of the person with AIDS if there is any blood you might touch. Use these gloves one time, then throw them away. Do not use latex gloves more than one time even if they are marked "reusable." You can buy hospital-type gloves by the box at most drug stores, along with urinals, bedpans, and many other medical supplies. Many insurance companies and Medicaid will pay for these gloves if the doctor writes a prescription for them. For cleaning blood or bloody fluids from floors, bed, etc., you can use household rubber gloves, which are sold at any drug or grocery store. These gloves can be cleaned and reused. Clean them with hot, soapy water and with a mixture of bleach and water (about 1/4 cup bleach to 1 gallon of water). Be sure not to use gloves that are peeling, cracked, or have holes in them. Don't use the rubber gloves to take care of a person with AIDS; they are too thick and bulky.

To take gloves off, peel them down by turning them inside out. This will keep the wet side on the inside, away from your skin and other people. When you take the gloves off, wash your hands with soap and water right away. If there is a lot of blood, you can wear an apron or smock to keep your clothes from getting bloody. (If the person with AIDS is bleeding a lot or very often, call the doctor or nurse.) Clean up spilled blood as soon as you can. Put on gloves, wipe up the blood with paper towels or rags, put the used paper towels or rags in plastic bags to get rid of later, then wash the area where the blood was with a mix of bleach and water.

Since HIV can be in semen, vaginal fluid, or breast milk just as it can be in blood, you should be as careful with these fluids as you are with blood.

If you get blood, semen, vaginal fluid, breast milk, or other body fluid that might have blood in it in your eyes, nose, or mouth, immediately pour as much water as possible over where you got splashed, then call the doctor, explain what happened, and ask what else you should do.

Needles and Syringes

A person with AIDS may need needles and syringes to take medicine for diseases caused by AIDS or for diabetes, hemophilia, or other illnesses. If you have to handle these needles and syringes, you must be careful not to stick yourself. That is one way you could get infected with HIV. Use a needle and syringe only one time. Do not put caps back on needles. Do not take needles off syringes. Do not break or bend needles. If a needle falls off a syringe, use something like tweezers or pliers to pick it up; do not use your fingers. Touch needles and syringes only by the barrel of the syringe. Hold the sharp end away from yourself.

Put the used needle and syringe in a puncture-proof container. The doctor, nurse, or an AIDS service organization can give you a special container. If you don't have one, use a puncture-proof container with a plastic top, such as a coffee can. Keep a container in any room where needles and syringes are used. Put it well out of the reach of children or visitors, but in a place you can easily and quickly put the needle and syringe after they are used. When the container gets nearly full, seal it and get a new container. Ask the doctor or nurse how to get rid of the container with the used needles and syringes.

If you get stuck with a needle used on the person with AIDS, don't panic. The chances are very good (better than 99%) that you will not be infected. However, you need to act quickly to get medical care. Put the needle in the used needle container, then wash where you stuck yourself as soon as you can, using warm, soapy water. Right after washing, call the doctor or the emergency room of a hospital, no matter what time it is, explain what happened, and ask what else you should do. Your doctor may want you to take medicine, such as AZT. If you are going to take AZT, you should begin taking it as soon as possible, certainly within a few hours of the needlestick.

Wastes

Flush all liquid waste (urine, vomit, etc.) that has blood in it down the toilet. Be careful not to splash anything when you are pouring liquids into the toilet. Toilet paper and tissues with blood, semen, vaginal fluid, or breast milk may also be flushed down the toilet. Paper towels, sanitary pads and tampons, wound dressings and bandages, diapers, and other items with blood, semen, or vaginal fluid on them cannot be flushed should be put in plastic bags. Put the items in the bag, then close and seal the bag. Ask the doctor, nurse, or local health department about how to get rid of things with blood, urine, vomit, semen, vaginal fluid, or breast milk on them. If you can't have plastic bags handy, wrap the materials in enough newspaper to stop any leaks. Wear gloves when handling anything with blood, semen, vaginal fluids, or breast milk on it.

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